Аннотация:Spontaneous intracranial hypotension (SIH) syndrome most often occurs following a cerebrospinal fluid (CSF) fistula that develops in thespinal space. Neurologists and neurosurgeons lack an understanding of the pathophysiology and diagnosis of this disease, which can maketimely surgical care difficult. With the correct diagnostic algorithm, it is possible to identify the exact location of the liquor fistula in 90% ofcases; subsequent microsurgical treatment can save the patient from the symptoms of intracranial hypotension and restore the ability to work.Female patient, 57 years old, was admitted with SIH syndrome. Magnetic resonance imaging (MRI) of the brain with contrast confirmed signsof intracranial hypotension. Computed tomography (CT) myelography was performed to pinpoint the location of the CSF fistula. The diagnosticalgorithm and successful microsurgical treatment of a patient with spinal dural CSF fistula at the Th3‑4 level using a posterolateral transduralapproach. The patient was discharged on day 3 after the surgery when these complaints regressed completely. At the control examination ofthe patient 4 months postoperatively, there were no complaints. Identification of the cause and location of spinal the CSF fistula is a complexprocess that requires several stages of diagnosis. Examination of the entire back with MRI, CT myelography, or subtraction dynamic myelographyis recommended. Microsurgical repair of a spinal fistula is an effective method for the treatment of SIH. The posterolateral transdural approachis effective in the repair of a spinal CSF fistula located ventrally in the thoracic spine
